Case Manager Job – How to Qualify for a Case Manager Job

A case manager job involves the use of managed care techniques within the coverage of the health care system of the U.S. case management. It is a multifaceted process where people who are covered are identified and for each case the most efficient treatment plan formulated and then implemented in order to have the most cost effective results. It focuses on giving personalized service to patients in order to improve the care given to them and has four steps: 1) recommending new patients; 2) planning and delivery of care; 3) evaluation of results and adjustment of care given if needed; and 4) overall evaluation of the effectiveness and adjustment of the program. Healthcare professionals holding a case manager job have several roles to fulfill and their responsibilities include:

a) Ensure patients have advocates for their needed services and education if any is needed.
b) Coordinate various kinds of care to help patient progress.
c) Giving the patient appropriate level of care.


d) Manage utilization of resources and refunds for services.
e) Monitor to make sure desired goals for both patient and hospital are achieved and intervene if needed.
f) Assess and address psychosocial needs of patients including individual, familial and environmental needs.
g) Identify areas that need improvement in practice using data based on evidence to influence practice changes.

There are specific types of case management programs including large claim or catastrophic management programs, maternity cases, and management programs for transitional care and a case manager job can have different functions depending on where they are employed. In a health insurance and HMO setting case managers can do the following:
1) Check for available benefits
2) Negotiate rates
3) Recommend exceptions to coverage
4) Organize referrals
5) Arrange special services
6) Coordinate other benefit plans with claims
7) Coordinate community services with insured services

By determining the patients with life threatening conditions, contacting them and coordinating their care, expenses can be reduced and the medical care they receive can be improved. In a health care provider setting case managers can do the following: 1) Verify with the insurance providers the benefits and coverage to be sure they are paid accordingly
2) Coordinate services needed for discharge
3) Make the patient aware of the case management program they are in
4) Follow up on the patients after they finish the case management program
5) Coordinate other health care providers with services

From an employer setting case managers can do the following: 1) check for medical reasons why an employee is absent; 2) follow up on employees who are absent due to illness; 3) make employees aware of case management programs; 4) provide assistance to employees with chronic illness; and 5) provide wellness programs.

To qualify for a case manager career you must either be medical or mental health worker such a social worker or nurse. These positions require at least a bachelor’s degree in clinical health courses although employers usually prefer applicants with master’s degrees. The transition to case management is a natural advancement of skill for almost all degree courses in healthcare. Undergraduate or graduate programs are provided for training of case managers that teach students how to correctly communicate with patients, analyze findings, support health needs, and discover the best way to implement the healthcare necessary. The three most commonly accepted educational attainments for case management positions are Bachelor of Social Work (BSW), Master of Social Work (MSW), and Master of Science in Nursing (MSN). After completing training in case management, social work candidates need to obtain a license to practice based on a specific amount of accumulated practical experience and passes an exam while nursing candidates must possess a valid license as a registered nurse. Work experience in healthcare is also required for those applying for case management positions. Case managers can further enhance their career advancement chances by acquiring certifications in case management. There are several associations that give these out after successfully completing a written exam, including the American Case Management Association (ACMA), the Case Management Society of America (CMSA), the National Academy of Certified Care Managers (NACCM), and the Commission for Case Manager Certification (CCMC).

The occupational outlook for a case manager employment is excellent and expected to grow around 34 percent by 2016 due primarily to a growing population of elderly people and also a growing need for social service professionals. The median annual wage for case managers was around $60,000 in 2008.

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